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The most common type of cast, hyaline casts are solidified Tamm–Horsfall mucoprotein secreted from the tubular epithelial cells of individual nephrons. Low urine flow, concentrated urine, or an acidic environment can contribute to the formation of hyaline casts, and as such, they may be seen in normal individuals in dehydration or vigorous exercise.
Examples of urinary casts: a) RTE cell cast, b) "muddy" granular cast, c) white blood cell cast, d) red blood cell cast [112] Urinary casts are cylindrical structures composed of Tamm-Horsfall glycoprotein. Their shape derives from the renal tubules where they are formed, and the protein base can incorporate cells or other material. Hyaline ...
Myeloma cast nephropathy, also referred to as light-chain cast nephropathy, is the formation of plugs (urinary casts) in the kidney tubules from free immunoglobulin light chains leading to kidney failure in the context of multiple myeloma. It is the most common cause of kidney injury in myeloma.
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The minor criteria are the following: a low urine volume (less than 500 mL (18 imp fl oz; 17 US fl oz) per day), low sodium concentration in the urine, a urine osmolality that is greater than that in the blood, the absence of red blood cells in the urine, and a serum sodium concentration of less than 130 mmol/L. [3]
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Diagnosis is made by a FENa (fractional excretion of sodium) > 3% and presence of muddy casts (a type of granular cast) in urinalysis. On histopathology, there is usually tubulorrhexis , that is, localized necrosis of the epithelial lining in renal tubules, with focal rupture or loss of basement membrane. [ 5 ]